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Research summary: Effect of dental treatment before cardiac valve surgery, a systematic review

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A recently published systematic review entitled, Effect of dental treatment before cardiac valve surgery, systematic review and meta-analysis, had the objective to determine the effect of dental treatment prior to cardiac valve surgery (CVS) or left ventricle assist device (LVAD) implantation on morbidity and mortality.

While there is debate concerning the potential benefits of dental treatment before CVS or LVAD, this review found no clear evidence of differing outcomes between patients who received dental treatment prior to CVS and those who did not.

Study Purpose

  • “To determine the potential effects of dental procedures performed as presurgical preparation, in any setting, in adults before CVS or LVAD implantation compared with results with no dental pretreatment on morbidity and mortality outcomes.”

This systematic review was conducted in response to the American Dental Association (ADA) House of Delegates resolution 86H-2016, directing the ADA to address optimising dental health before specific surgical or medical procedures and treatment. As such, the reviewers’ search strategy was developed and guided by an interdisciplinary panel with expertise in cardiology, general dentistry, oral medicine, and infectious diseases.

All relevant reviewed studies evaluated professional dental treatment.

The authors evaluated various outcomes in this review including:

  • All-cause mortality
  • Infective endocarditis (IE)
  • Postsurgical infection rates
  • Length of stay in hospital (LOS)

Studies involving nonsurgical treatment of heart valve disorders, heart failure, and interventions limited to treatment of coronary artery disease, atrial fibrillation, or pacemaker management were excluded.

Results

According to the reviewers’ findings, it is unclear whether dental treatment before CVS results in better or worse postoperative outcomes than no dental pretreatment. The reviewers indicated that “Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not.”

Overall, reviewers recommend dentists and medical professionals collaborate and weigh each patient’s relevant care considerations. They also encourage discussion with surgical and medical teams to determine the best course of action concerning a patient’s oral health status, potential for delays in medical health care or an acute exacerbation during hospitalization or the postoperative period, and other factors outside the scope this review.

Clinical Implications

Until more definitive studies are done, teams of dental, medical, and surgical care professionals should collaboratively consider case-specific factors before proceeding with presurgical dental treatment.

Article: Effect of dental treatment before cardiac valve surgery, systematic review and meta-analysis.

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1 Comment

  1. Susan Sutherland September 26, 2019

    This is no surprise. Although there are significant associations that involve the oral microbiome, inflammation and many systematic diseases, it is time for dentistry to focus on the importance of the mouth and orofacial complex as important systems on their own throughout the life span. Instead of trying to find “causal” relationships for associations that are sometimes spurious, we need to support and fund basic science and clinical research into inflammation and the microbiome, ensure that dentists are trained to provide safe care to medically complex patients and can function collaboratively within a patient centred health care system.

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